Covid antibody and antiviral treatments

An updated summary of currently available treatments, eligibility criteria and how to refer

This information is sourced from PULSE , NHSE, the DHSC and the MHRA:

Currently available therapeutics

There are currently two first-line options:

Paxlovid (a combination of two antiviral medications – PF-07321332 (nirmatrelvir) and ritonavir. Three tablets taken twice a day for five days. 88% Relative Risk Reduction of Hospitalisation
Sotrovimab (a single intravenous infusion of a neutralising monocolonal antibody- nMAB). 85% Relative Risk Reduction of Hospitalisation

Second-line:

Remdesivir (an intravenous antiviral medication given once a day for three days). 87% Relative Risk Reduction of Hospitalisation

Third-line:

Molnupiravir (four oral antiviral tablets given twice a day for five days). 30% Relative Risk Reduction of Hospitalisation

Choice of antiviral/nMAB

There are multiple factors which influence the choice of appropriate treatment (detailed here). For example:

Paxlovid has multiple significant drug-drug interactions and cannot be used in pregnant women or under 18s
Remdesivir can be used within 7 days of symptom onset (all others therapeutics must be started within 5 days)
Molnupiravir has a substantially lower level of efficacy and should be reserved for when others cannot be used

Eligibility for treatment

Onset of of Covid-19 symptoms within the last 5 days (for Paxlovid, Sotrovimab and Molnupiravir) or 7 days (Remdesivir)
Remains symptomatic and with no signs of clinical recovery
SARS-CoV-2 infection confirmed by either PCR or lateral flow test (registered via gov.uk) or 119
The patient is a member of a highest risk group

Patient cohorts considered at highest risk from Covid-19 eligible for treatment with nMAB or antivirals

Patients eligible for treatment with nMAB or antivirals

The following high-risk patients will be eligible for treatment:

Down’s syndrome and other genetic conditions that might reasonably be expected to reduce immune competence
Patients with a haematological diseases and stem cell transplant recipients
Solid cancers, or patients who have received radiotherapy within the last six months or chemotherapy within the last 12 months
Certain patients with a haematologic malignancy – eg, those within 12 months of a stem cell transplant, who have active graft vs host disease or who are within 3-6 months of various therapies
Renal disease including those with a transplant (or a failed transplant within the last 12 months), all those with CKD 4 or 5 and those who have had B cell depleting therapy in the past 12 months or are otherwise immunosuppressed
Liver disease including cirrhosis, transplant and immunosuppression due to therapy for liver disease
Immune mediated inflammatory disorders, including immunosuppression due to medication
Primary immune deficiencies
HIV or AIDS where the viral load is high or the CD4 count is <350 cells/mm³(or > cells/mm³that with additional risk factors)
Recipients of solid organ transplants not covered in other categories
Neurological conditions – multiple sclerosis, motor neurone disease, myasthenia gravis and Huntington’s disease

These criteria are being regularly updated here (see appendix 1 page 12)

Non eligible for treatment:

Clinical presentation indicates recovery rather than risk of deterioration from infection
Require hospitalisation or supplemental oxygen for Covid-19
Children weighing less than 40kg
Children aged under 12 years
Known hypersensitivity reaction to the active substances or excipients

Accessing treatment

Most highest risk patients have received a letter or email telling them in advance they may be eligible for these treatments in the event they test positive for Covid-19
They should have also automatically receive a priority PCR test to keep at home
The public are advised to call 119 if they think they may be eligible for treatment but have not received a test kit by 10 January 2022
Eligible patients should then be contacted by their local Covid Medicine Delivery Unit (CMDU) if they have a positive PCR or lateral flow test registered on gov.uk or registered with 119
If an eligible patient is not contacted by their local CMDU within 24 hours of a positive PCR test GPs should refer them urgently

How GPs can refer

via e-RS under the ‘Infectious Diseases’ specialty and clinic type ‘Not otherwise specified’ to Covid Medicine Delivery Unit (CMDU)
Include patient details, the date of the PCR or test, and the condition(s) that you think might make them eligible for treatment

Other at risk groups not currently eligible for treatment

Oral antivirals are also available to a wider cohort of at-risk patients through a national study known as PANORAMIC. Patients can join the PANORAMIC study if they:

have been unwell with Covid-19 for less than five days
have a recorded positive PCR or lateral flow test
are aged 50 and over
or aged between 18 to 49 years with a listed pre-existing condition underlying health conditions that make them clinically more vulnerable (list of conditions is on this panoramic participant information link)